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Accidente cerebrovascular hemorrágico

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  • Descripción general
  • Teoría
  • Diagnóstico
  • Manejo
  • Seguimiento
  • Recursos
Last reviewed: 10 Aug 2025
Last updated: 12 Mar 2024

Summary

Definition

History and exam

Key diagnostic factors

  • rigidez de nuca
  • antecedentes de fibrilación auricular
  • antecedentes de hepatopatía
  • cambios en la visión
  • fotofobia
  • inicio repentino seguido de avance
  • sensación alterada
  • cefalea
  • debilidad
  • pérdida sensorial
  • afasia
  • disartría
  • ataxia
  • antecedentes de trastorno hematológico
  • vértigo
  • náuseas y vómitos
  • alteración del nivel de consciencia/coma
  • confusión
  • paresia de la mirada
Full details

Risk factors

  • hipertensión
  • edad avanzada
  • sexo masculino
  • Etnia asiática, de raza negra y/o etnia hispana
  • antecedentes familiares de accidente cerebrovascular hemorrágico
  • hemofilia
  • angiopatía amiloide cerebral
  • anemia falciforme
  • mutaciones autosómicas dominantes en el gen COL4A1
  • telangiectasia hemorrágica hereditaria
  • mutaciones autosómicas dominantes en los genes KRIT1, CCM2, o PDCD10
  • anticoagulación
  • simpaticomiméticos ilegales
  • malformaciones vasculares
  • tabaquismo
  • antiinflamatorios no esteroideos (AINE)
  • apnea obstructiva del sueño
  • diabetes mellitus
  • abuso de alcohol grave
  • vasculitis cerebral
  • trombocitopenia
  • sueño de larga duración y mala calidad del mismo
  • enfermedad de Moyamoya
  • embarazo
  • leucemia
Full details

Diagnostic investigations

1st investigations to order

  • TC de la cabeza sin contraste
  • perfil de bioquímica sanguínea
  • hemograma completo (HC)
  • pruebas de coagulación
  • electrocardiograma (ECG)
  • prueba de la función plaquetaria
  • cribado de tóxicos en orina
  • prueba de embarazo en mujeres en edad fértil
  • prueba de función hepática
  • puntuación de la hemorragia intracerebral (HIC)
Full details

Investigations to consider

  • angiografía por TC y flebografía
  • angiografía por resonancia magnética y flebografía
  • angiografía convencional (invasiva)
  • imagen por resonancia magnética (IRM) cerebral
  • IRM cerebral con imágenes ponderadas en difusión (DWI) y secuencia eco de gradiente (GRE)
  • IRM cerebral con imagen de susceptibilidad magnética
Full details

Treatment algorithm

INITIAL

accidente cerebrovascular hemorrágico posible

ACUTE

sangrado no cerebeloso: estable y alerta

sangrado no cerebeloso: descompensación

sangrado cerebeloso <3 cm: alerta

con sangrado cerebeloso >3 cm o somnoliento/inestable

Contributors

Authors

Fernando D. Goldenberg, MD

Clinical Associate of Neurology

Medical Director, Neuroscience ICU

Director, Neurocritical Care Education

Co-Director, Stroke Center

University of Chicago

Chicago

IL

Disclosures

FDG declares that he has no competing interests.

Raisa C. Martinez, MD

Neurocritical Care Unit

Department of Neurosciences

Wellstar Health System, Kennestone

Marietta

GA

Disclosures

RCM declares that she has no competing interests.

Acknowledgements

Dr Fernando Goldenberg and Dr Raisa Martinez would like to gratefully acknowledge Dr Alejandro Hornik, Dr Eric E. Smith, and Dr T. Dion Fung, the previous contributors to this topic.

Disclosures

EES is an author of a number of references cited in this topic. AH and TDF declare that they have no competing interests.

Peer reviewers

Louis R. Caplan, MD

Lecturer in Neurology

Hospital Chief

Cerebrovascular/Stroke Division

Beth Israel Deaconess Medical Center

Division of Cerebrovascular/Stroke

Boston

MA

Disclosures

LRC declares that he has no competing interests.

Julien Morier, MD

Neurology Registrar

Neurology Service

Centre Hospitalier Universitaire Vaudois (CHUV)

Lausanne

Switzerland

Disclosures

JM declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Greenberg SM, Ziai WC, Cordonnier C, et al. 2022 Guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Stroke. 2022 Jul;53(7):e282-361.Full text  Abstract

Intercollegiate Stroke Working Party. ​The National clinical guideline for stroke for the United Kingdom and Ireland. Apr 2023 [internet publication].Full text

Kleindorfer DO, Towfighi A, Chaturvedi S, et al. 2021 guideline for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline from the American Heart Association/American Stroke Association. Stroke. 2021 Jul;52(7):e364-e467.Full text  Abstract

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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